ABSTRACT
Introduction: Coronary bifurcation lesions are considered one of the challenging entities in the field of coronary intervention due to the risk of side branch loss and higher risk of stent thrombosis. However, there is limited data about the proper management of such lesions in the setting of myocardial infarction as most bifurcation lesion studies excluded patients with acute coronary syndromes (ACS). The aim of this study was to compare in-hospital and mid-term outcomes of single-stent and two-stents strategy in the management of bifurcation culprit lesions in patients presenting with anterior STEMI. Methods: This retrospective multi-center study included all patients presented with anterior STEMI who underwent primary PCI between January 2017 and December 2019, coronary angiography showed true bifurcation lesion with sizable side branch that can be managed by stenting. Patients with left main bifurcation, those indicated for urgent CABG, and patients in cardiogenic shock were excluded. Included patients were divided into two groups according to the stenting strategy either single or two stents. Six months follow up data were collected by telephone calls and by examination of medical records. Results: Out of 1355 anterior STEMI patients presented between January 2017 and December 2019, 158 patients (11.6%) were identified to have bifurcation culprit lesions with a sizable diagonal branch. 93 patients (59%) were treated by single stent while 65 patients (41%) were managed by two-stents strategy. The baseline characteristics and angiographic findings were similar in both groups except for higher side branch involvement in the two stents group (83.31%±11.20 vs 71.88%±15.05, t= -5.39, p <0.001). Mean fluoroscopy time (23.96±8.90 vs 17.81±5.72 mins) and contrast volume (259.23± 59.45 vs 232.58± 96.18 ml) were significantly higher in two stents group than single stent group (p=0.049). However, the angiographic success rates (residual stenosis ?30% and restoration of TIMI flow grade II or III) were comparable (96.8% vs 99%, MCp=0.151). There is no significant difference in the overall incidence rate of MACE in both groups 6 months following the index procedure (13.9 % vs 16.9%, FEp=0.698), with no difference between different bifurcation stenting techniques in patients managed with two stents. Conclusion: Although two stents strategy in the setting of STEMI is much complex with more fluoroscopy time and contrast volume, the procedural success rate and the incidence of MACE were comparable to one stent strategy, on medium-term follow up.
ABSTRACT
Percutaneous coronary intervention is the main treatment of coronary heart disease. Both the original bare metal stent and drug-coated stent have the possibility of developing in-stent restenosis, and have poor therapeutic effect on small vessel lesions and bifurcation lesions, which limit their clinical application. In recent years, drug-coated balloons have made considerable progress. They provide a new treatment method for in-stent restenosis, chronic total occlusion, bifurcation lesions and small vessel lesions, and can shorten the duration of dual antiplatelet therapy and reduce the risk of bleeding. This paper reviews the clinical research progress of drug-coated balloon.
ABSTRACT
Background: Kissing Balloon Inflation (KBI) technique was the first technique for percutaneous intervention in bifurcation lesions. It's the standard strategy in the two-stent procedure. Its benefit in one-stent approach remains uncertain. Several trials comparing KBI strategy with the No-KBI strategy in one-stent technique did not show any advantages in the clinical outcome. Clinical outcome and the follow up of ischemic symptoms is a useful method to compare the effectiveness of both strategies.Aims: To study the short-term clinical outcome (3and 6 months) of provisional versus routine kissing‑balloon technique after main vessel stenting for coronary bifurcation lesions.Patients and Methods: The study included sixty consecutive patients. They were randomized to receive different side branch (SB) intervention strategies: group I (provisional final kissing balloon inflation group -PFKBI) (FKBI only when SB Flow less than TIMI 3) and group II (routine final kissing balloon inflation group –RFKBI).Results: 1-Dissection of side branchand conversion to two stent strategy was significantly higher in PFKBI group (14,3%) than in RFKBI group (0) 2-The amount of dye, total procedure time and time of admission was significantly higher in RFKBI group. 3-Chest pain immediately after the procedure was significantly higher in PFKBI group while at 3 and 6 months follow up no significant difference between both groups was noticed. 4-MACE, target lesion revascularization (TLR) and stent thrombosis were similar between both groups at 3 and 6 months.Conclusions: Main vessel stenting with and without final kissing balloon dilatation was associated with favorable and similar 3 and 6-month clinical outcomes
ABSTRACT
Background Bifurcation lesions account for 15–20% of interventions carried out in a catheterization laboratory. Several techniques have been described for treating bifurcation lesions of which culotte and T-stenting and protrusion(TAP) are commonly used. Both these techniques involve recrossing the struts of primary stent, failing which the flow in second branch which can be impaired and lead to catastrophic events. In this study, we describe a novel balloon embedded stenting technique which can be incorporated with traditional culotte or TAP technique and facilitates conversion to bail out crush in case of such an event. Methods and results 28 patients who were treated with balloon embedded stenting for bifurcation lesions were included in the study. Angiographic and procedural success were achieved in all the patients. Primary stent could not be recrossed in 1 patient, who was successfully converted to bail out crush using the technique. There were no complications during the procedure. Mean fluoroscopy time and contrast volume was similar to that of conventional culotte and TAP. Conclusion The present study suggests that incorporation of balloon embedded stenting into traditional culotte or TAP technique is achievable and can facilitate conversion to bail out crush when required.
ABSTRACT
Objective To explore the predictive factors of side branch occlusion in patients with ST-segment elevation myocardial infarction by coronary angiography. Methods A total of 1223 patients with acute ST segment elevation myocardial infarction undergoing primary percutaneous coronary intervention were consecutively enrolled in Fuwai hospital from January 2014 to December 2015. According to the coronary angiography there were 256 patients with bifurcation in the culprit lesions. Demographic data, past medical history and coronary angiography characteristics were collected in all patients. Results Among the 256 patients, there were 33 patients with branch occlusion and 223 patients without branch occlusion. Multivariate analysis demonstrated that severe stenosis of side branch ostium odds ratio 1.06, 95% confi dence interval 1.03-1.09,P < 0.001) and thrombus in side branch ostium (odds ratio 5.43, 95% confidence interval 1.23-23.93, P=0.025) were independent risk factors for predicting branch occlusion. Conclusions Side branch occlusion in culprit lesions of patients with ST-segment elevation myocardial infarction is related to the severity of branch ostium stenosis and thrombosis in branch ostium.
ABSTRACT
Objective To explore the gender difference in clinical features and outcomes of elderly patients with coronary true bifurcation lesions after percutaneous coronary intervention (PCI).Methods A total of 169 consecutive patients were included in the study, who were diagnosed coronary true bifurcation lesions by coronary angiography (CAG)and received PCI in our hospital from December 2013 to December 2015.All patients were divided into 2 groups according to their gender (71 femals and 98 males).Angiographic characteristics of the coronary lesions and clinical data were analyzed in both groups.Clinical outcomes during follow up were recorded and studied.Results The levels of total cholesterol (TC), triglyceride (TG),high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) in the female group were significantly higher than in the male group (all P0.05).The median follow-up time was 17 months and the incidence rate of overall adverse events in women was higher than that of men (25.4% vs.11.2%, P<0.05).Conclusions The clinical outcomes of elderly patients with coronary true bifurcation lesions after PCI had gender differences.The rates of adverse events in female patients was found significantly higher than male patients.
ABSTRACT
Objective To explore the effectiveness and safety of branch protection technique with provisional stenting strategy in coronary bifurcation lesions by utilizing jailed balloon protection technique after pre-dilation in branch with cutting balloon. Methods 32 patients undergone jailed balloon protection technique after pre-dilation in branch with cutting balloon during January, 2015 to May, 2016 in Peking University of People's Hospital were enrolled consecutively in our study. 32 patients were involved including a total of 32 bifurcation lesions which were medina type 1,1,1 (n = 25, 78. 1% ), Medine type 0,1,1 (n =5,15. 6% ) and Medine type 1,0,1 (n = 2, 6. 3% ). For side branch diameter ≥2. 5 mm, the diameter ratio of cutting balloon to side branch was 1: 1. The angiography success rate after using branch protection during main branch stent implantation, perioperative complications and major adverse cardiac events were observed. Results ( 1 ) The angiography success rate of branch protection was 100% . ( 2 ) No perioperative complications and major adverse cardiac events were observed. Conclusions Side branches were effectively protected in provisional stenting strategy by applying jailed balloon protection technique after pre-dilation using branch cutting balloon.
ABSTRACT
Objective To evaluate the feasibility of jailed-balloon technique(JBT) in the treatment of true coronary bifurcation lesions.Methods From March 2013 to October 2014,a total of 71 patients who received coronary angiography,were diagnosed as true coronary bifurcation lesions and then underwentpercutaneous coronary intervention(PCI) in the Department of Cardiology of the Second Affiliated Hospital of Kunming Medical University was divided into group A(jailed balloon side branch protection group,28 cases) and group B(traditional side branch protection group,43 cases).The perioperative complications,X-ray exposure time,the number of intervention supplies,the total expenses,the incidence of adverse cardiovascular events and other indicators between the groups were compared,and the feasibility of JBT was evaluated.Results There were no significant differences between the two groups in perioperative complications(P＞0.05),postoperative adverse cardiovascular events and restenosis rate of side branch after angiography(P＞ 0.05),but the PCI related indicators (including the balloon use number,PCI operation time,the amount of X-ray exposure,wire number,the amount of contrast agent and operation cost) in group A were significantly lower than those in group B(P＜0.05).Conclusion JBT applied in the treatment of true coronary bifurcation lesions can reduce the operative time,X-ray irradiation time and related medical expenses.
ABSTRACT
Objective: To evaluate the safety and efifcacy of cutting balloon combining main branch single stent cross-over technique for treating the patients with coronary bifurcation lesions. Methods: A total of 113 patients with 121 bifurcation lesions treated in our hospital from 2012-01 to 2014-01 were enrolled. Cutting balloon pre-dilation was applied in both main and side branches followed by drug-eluting stent implantation at main branch. The procedural success rates, side branch blood lfow status and complications were observed. Follow-up studied for MACE occurrence was conducted at 9 months after the operation. Results: Quantitative coronary angiography (QCA) presented that the minimum lumen diameters at pre- and post-operation in main branches were (2.12 ± 1.07) mm and (3.24 ± 0.87) mm, in side branches were (1.44 ± 0.73) mm and (1.82 ± 0.64) mm respectively,P<0.05-0.01, the procedural success rate was 100%. There were 11 (9.1%) lesions with dissection at proximal side branch, 5 (4.1%) lesions with side branch TIMI blood lfow
ABSTRACT
Objective To report our first clinical experience with a novel modified culotte technique for the treatment of true coronary bifurcation lesions. Methods The novel modified culotte technique (the mono-ring culotte) stenting was done in which the side branch (SB) stent was deployed firstly followed by ex vivo wiring of a most proximal cell of SB stent with the hard end of main branch (MB) wire. Secondly, the MB stent was deployed through the most proximal cell of SB stent. The procedure was ended with kissing balloon dilation. From June 2014 to March 2015, 15 patients with true coronary bifurcation lesion were treated with mono-ring culotte stenting in our center. Results The procedures were successful in all cases without procedural complication and in-hospital major adverse cardiovascular events. The procedural time was (34. 3 ± 9. 6) min, fluoroscopic time was (18. 1 ± 3. 8) min, and contrast volume was (112. 0 ± 24. 5) ml, respectively. Post-procedurally, the residual stenosis of the main and the side branch were (10. 0 ± 2. 5)% and (10. 2 ± 5. 3)% , respectively. Conclusions The mono-ring culotte stenting is safe and feasible for treatment of true coronary bifurcation lesions, and may be superior to the conventional culotte stenting.
ABSTRACT
Objective To explore the protective effect of a small balloon on bifurcation lesions by applying a single stent treatment of coronary bifurcation lesions strategy. Methods Fifty patients with coronary bifurcation lesions were randomly divided into A group and B group( 25 cases for each group ). Patients in A group were treated with the pre-entry protection branch guide wire to complete the main branch balloon pre-dilation,stenting,while in B group were treated with the set aside the branches of a small balloon. The information of main branch balloon pre-dilation,stenting were recorded. The blood flow slowed down,the incidence of side branch occlusion or stent placement,and the incidence of postoperative 24 h troponin I( cTnI) levels were measured. Results Nine cases(36%)in A group occurred lower branch blood flow,which due to 4 cases(16% )with significantly narrow branch stenting,2 cases(8%)with complete occlusion. There were only 2 cases(8%)with decrease branching blood flow in B group,and the difference was significant(P=0. 041, 0. 022). The cases with higher cTnI after 24 h in A group were 11( 39%),significantly higher in group B (3(12 %);P =0. 027 ). Conclusion Compared with the traditional protection guidewire,the approach of setting aside a small balloon to protect important branch can effectively prevent important branch occlusion, branch involvement due to lower incidence of myocardial infarction.
ABSTRACT
Objective To investigate the relationship between the Minimum Lumen Area (MLA) and plaque burden(PB) of the left circumlfex (LCX) ostial and the occurrence of myocardial ischemia after a single stent crossover for the treatment of left main (LM) bifurcated lesions. Methods Intravascular ultrasound (IVUS) assessment was performed on 5 patients, each where coronary angiography showed left main bifurcated lesions, and to measure the MLA and PB of the LCX. Following a single stent crossover fractional lfow reserve (FFR) evaluation were performed in all 5 patients to investigate the relationship between the MLA and PB of the LCX ostium and the occurrence of myocardial ischemia. Results The mean MLA of the left main coronary of the 5 patients was (4.99±2.3) mm2 with the minimum lumen diameter (MLD) being (2.26±2.8) mm. The average MLA of the left anterior descending (LAD) ostial or proximal was (4.01±2.0) mm2, mean plaque burden (PB) at the LAD ostial or proximal was (68.15±10.1)%. Average MLA of LCX was (4.94±0.4) mm2 with a plaque burden of (66.00±6.0)%. Single stent crossover technique was used to treat the bifurcated lesions. Among the 5 patients, only 1 of them was treated with a double stent deployment where the LCX ostial FFR was0.75. Conclusions Integrated IVUS and FFR would achieve threshold measurements of MLA at LCX’s ostium which could predict ischemia after one stent strategy.
ABSTRACT
Objective To evaluate long-term outcome of simultaneous kissing sirolimus-eluting stent (SKS) technique versus single sirolimus-eluting stent (SSS) technique for percutaneous treatment of true coronary bifurcation lesions in large-size vessels.Methods This randomized study assigned 190 patients with a coronary bifurcation lesion to simultaneous kissing stenting (SKS) in both main and side branches and 190 patients to main vessel stenting only (SSS).The endpoints included restenosis,death,non-fatal myocardial infarction,target-lesion revascularization (TLR),stent thrombosis,success rate of percutaneous coronary intervention (PCI) and the operation duration.Results During 1-year follow-up,the SKS group and the SSS group had similar incidences of overall re stenosis [30 ( 15.8 ％ ) vs.24 ( 15.2 ％ ),x2=0.000,P＜0.05],mainbranch restenosis [20 ( 10.5％ ) vs.16 ( 10.1％ ),x2=0.003,P ＞ 0.05];side-branch restenosis [13 ( 6.8％ )vs.23 ( 14.6％ );x2=4.73,P＜0.05];death [2 ( 1.1％ ) vs.1 ( 0.6％ ),x2=0.026,P ＞ 0.05],non-fatal myocardial infarction [4 (2.1％ ) vs.2 ( 1.3％ ),x2=0.034,P ＞ 0.05],TLR [23 ( 12.1％ ) vs.20 ( 12.7％ ),x2=0.000,P ＞ 0.05] and stent thrombosis [4 (2.1％ ) vs.2 ( 1.3 ％ ),x2=0.034,P ＞ 0.05] and a shorter operation duration[(20 ± 8) min vs.(45 ± 9) min,t=1.98,P＜0.05] than the SSS group.Conclusion For true coronary bifurcation lesions in large-size vessels,SKS and SSS have similar long-term outcomes.The SKS group has a higher success rate of PCI and shorter operation duration.
ABSTRACT
@#Objective To evaluate the immediate and long-term outcomes of left main bifurcation lesions using different stenting techniques.Methods 27 patients undergone unprotected left main coronary artery stenting had been analyzed.14 cases with simple stenting techniques and 13 cases with complex stenting techniques were involved.Results 40 coronary stents were deployed in 27 patients.The procedural success rate was 100%.No major adverse cardiac events(MACE)had developed in hospital.More true bifurcation lesions were involved in complex stenting group than in simple stenting group(84.6% vs 14.3%,P=0.0004),as well as multivessel lesions involved(100% vs 57.1%,P=0.0074).The residual ostial restenosis of left anterior descending artery(LAD)in complex stenting techniques group was more than that in simple stenting techniques group((4.29±4.25)vs(10.85±5.51),P=0.002).The residual ostial restenosis of left circumflex artery(LCX)in complex stenting group was less than that in simple stenting group((4.61±3.01)vs(13.63±11.21),P=0.009).The patients were followed up for 2～53 months.Angina pectoris recurred in 3 cases(11.1%)and target lesion revascularization(TLR)developed in 2 cases(7.41%).The total MACE happened in 2 cases(7.41%).There was no significant difference between complex stenting group and simple stenting group about symptom recurrence(7.1% vs 15.4%,P=0.59)and TLR(0 vs 15.4%,P=0.13).Conclusion Both simple and complex stenting techniques are feasible with better in-hospital and long-term outcomes.